1985, 10-18 Permit App: 00008823 FurnaceMECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
ADATEPPLICATION /6„
Project #23
Owner's Name Last First. MI
Project Address (Street Name & Number)
-> '"ii(C. /1_,4,6",e, K
City
State
Subdivision lPlat Name
Assessors Parcel #Lot
Ce
Block
Plat #
Appl IAddress
/1 (�/S/ e4'.., -----j ��/�.
/fell . �ilC! S
`_�Clty ��,., !1
ase",-
State
Zip
Phone
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact Lice se,
,iideD2 / //6 /1.2A/
Business Phone
De tribe Wo ,J
c..&// X 4,7 / C L.�if�//� 2/�' '" . A/a i C ,
�'
Fans
Evaporative Cooler /
Hoods
Electric�urna Duct'
Miscellaneous
Solid Fuel /Wood Stove
Dryer
Range
Gas Log
Gas Water Htr.
Air Handling Units
0-10,000 CFM
10,000+ CFM
,
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50H P
50 + HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU /
/
10%,,;00+BTU
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
ADATEPPLICATION /6„